ICU院内感染革兰阴性杆菌的耐药性分析

Analysis of the Gram-negative Bacilli Resistance of Nosocomial Infection in Intensive Care Unit

目的 :了解我院重症监护病房 (ICU)院内感染的革兰阴性杆菌的耐药性变化趋势。方法 :采用浓度梯度法(Etest法 )检测我院 1999～ 2 0 0 3年重症监护病房院内感染的各类感染标本中分离的 5 6 3株革兰阴性杆菌的最低抑菌浓度 (MIC) ,并对其耐药性进行分析。结果 :主要病原菌依次为铜绿假单胞菌 (2 6 .3% )、大肠埃希菌 (18.1% )、肺炎克雷伯菌 (15 .0 % )、肠杆菌属 (14 .6 % )、不动杆菌属 (12 .1% )、嗜麦芽窄食假单胞 (9.8% )等。 5 a间 ,各种抗菌药物的耐药性变化呈上升趋势。大肠埃希菌、肺炎克雷伯菌中产超广谱 β-内酰胺酶 (ESBL s)的发生率分别是 4 4 %和 4 2 % ,头孢噻肟、头孢他啶、环丙沙星、亚胺培南对铜绿假单胞菌的 MIC90分别是 2 5 6、2 5 6、32、16 mg/L。头孢噻肟、头孢他啶、庆大霉素、环丙沙星、对肠杆菌属、产 ESBL s大肠埃希菌、肺炎克雷伯菌的 MIC90分别是 2 5 6、32～ 2 5 6、2 5 6、6 4 mg/L,有较高的耐药性。结论 :加强细菌的感染监控 ,及时提供医院内感染菌株流行情况及其耐药率变迁信息 ,为合理使用抗菌药物提供依据 。

Objective:To investigate the resistance rate of the Gram-negative bacilli of Nosocomail infection in ICU.Methods:563 strains of nosocomial pathogens were isolated from January1,1999 to December 31,2003 in ICU of our hospital. Antibiotic resistance was conducted and E test was performed to measure the MIC.Results:Nosocomial infection in intensive care unit was highest among gram-negative bacteria,espectically Pseudomonas aeruginosa(26.3%), Pseudomonas aeruginosa were the most prevalent isolates from ICU infections followed by Escherichia coil(18.1%), Klebsiella pneumoniae(15.0%), Entrobacter (14.6%), Acinetobacter spp(12.1%),Xanthomonas sp(9.8%).44% strain of Escherichia coil and 42% strain Klebsiella pneumoniae could produce extended-spectrum beta-lactamases(ESBLs). MIC90 for cefotaxime, ceftazidime, ciprofloxacin and imipenem against Pseudomonas aeruginosa was 256、256、32、6 mg/L. MIC90 for cefotaxime, ceftazidime, gentamicin and ciprofloxacin against Entrobacter, ESBLs producing strains of Escherichia coil and Klebsiella pneumoniae were 256、32～256、256、64 mg/L. They were cross-resistance.Conclusions:Antibiotics policy should be urgently needed in order to delay the resistance development.